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Teacher’s PET Intake Form

Welcome to the Teacher’s PET program! Please complete the intake form below to enroll your child. The form has multiple steps—have your child’s information, emergency contacts, and household details ready before you begin.

"*" indicates required fields

Step 1 of 5

20%

URL

This field is for validation purposes and should be left unchanged.

Email*

Class start date you are interested in enrolling in.

MM slash DD slash YYYY

Child First Name*

Child Last Name*

Address*

City*

State*

Zip Code*

Phone Number*

Child's Email*

Which Race or Ethnicity best describes you?*

American Indian or Alaskan Native

Asian/Pacific Islander

Black or African American

Hispanic

White/Caucasian

I do not know or prefer not to say

Other:

Other:

Sex assigned at birth

Gender*

Male

Female

Transgender

Nonbinary

White/Caucasian

I do not know or prefer not to say

Other:

Other:

Age

School Currently Attending

Grade level*

Any past or present court involvement?

Single or Two Parent Home*

Single Parent

Two Parent

Other:

Other:

(other) Guardian's Name

Mother's Name

Mother's Phone Number

Mother's address if different than child's

Father's Name

Father's Phone Number

Father's email

Father's Address if different than child's

Emergency Contact Name*

Relationship to youth participant*

Emergency Contact Phone Number*

Emergency Contact Address

Untitled

Number of family members living in household

Housing

Are you a home owner or renter?

Rent

Home owner

Parental Agreement

As the parent or legal guardian of the child participating in the Teachers Pet Class, do hereby authorize my child to attend and participant in the “Teacher’s Pet” program. I hereby authorize the Toledo PET Bull Project volunteers to supervise youth only during session times and are not responsible for youth who leave the premises. I also hereby waive all claims against the “Teacher’s Pet” Program and their volunteers of any accidents, injuries, and/or wounds sustained by my child during their time at the “Teacher’s Pet” Program. I also grant my permission of the usage on any footage or pictures taken of my child for the “Teacher’s Pet” Program. I hereby acknowledge and authorize that the information contained in this Intake Form may be utilized by Toledo’s PET Bull Project and United North for referral and direct service purposes only. By typing your name bellow you acknowledge you are digitally signing this contract.

Date Signed*

MM slash DD slash YYYY

Please Type your full legal name*

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Toledo, OH 43613

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